Healthcare Provider Details

I. General information

NPI: 1518029453
Provider Name (Legal Business Name): EBONY HOUSE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1616 E INDIAN SCHOOL RD SUITE 100
PHOENIX AZ
85016-8601
US

IV. Provider business mailing address

6222 S 13TH ST
PHOENIX AZ
85042-4408
US

V. Phone/Fax

Practice location:
  • Phone: 602-254-6137
  • Fax: 602-254-6140
Mailing address:
  • Phone: 602-276-4288
  • Fax: 602-232-2938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberBH-3207
License Number StateAZ

VIII. Authorized Official

Name: SHEENA JONES
Title or Position: CEO
Credential:
Phone: 602-276-4288